Relation between use of health check ups starting in middle age and demand for inpatient care by elderly people in Japan

Psychological Distress in Responders and Nonresponders in a 5-year Follow-up Health Survey: The RIAS Study

BACKGROUND

People with poor health or mental conditions are generally unwilling to participate in the health examinations, and no studies have directly examined the relationship of psychological distress among disaster survivors with participation status to date. The present study thus examined psychosocial differences according to the respondent status in a 5-year follow-up survey among participants in the prospective health surveys on survivors of the Great East Japan Earthquake and Tsunami Disaster study in Iwate Prefecture, Japan.

METHODS

We analyzed data from 10,203 Japanese survivors aged ≥18 years (mean age, 65.6 years; 38.0% men) and who underwent health examinations at baseline in 2011. Participants were classified into responders and nonresponders according to their 2015 health examination participation status. Psychological distress was evaluated using the Kessler 6 scale and categorized as none, mild, and severe. Multinominal logistic regression was used to examine the risk of psychological distress in relation to participation status.

RESULTS

In the 2015 survey, 6,334 of 6,492 responders and 1,686 of 3,356 nonresponders were analyzed. The most common reasons for nonparticipation in the survey were participated in other health examinations, examined at a hospital, and did not have time to participate. Nonresponse in males was associated only with mild psychological stress, whereas nonresponse in females was associated with mild and severe psychological distress.

CONCLUSION

Nonresponders in the follow-up survey had a higher risk of psychological distress than responders. Continuous monitoring of the health of nonresponders and responders may help to prevent future health deterioration.

The Effect of Health Check-Ups on Health Among the Elderly in China: Evidence From 2011–2018 Longitudinal Data

Objectives: To assess the effect of health check-ups on health among the elderly Chinese.

Methods: The first dataset was panel data extracted from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Health Longevity Survey (CLHLS). The second dataset was cross-sectional data come from CLHLS 2018 linked with the lagged term of health check-ups in CLHLS 2011. Health check-ups were measured by a binary variable annual health check-up (AHC). Health was assessed by a binary variable self-rated health (SRH). A coarsened exact matching method and individual fixed-effects models, as well as logistic regressions were employed.

Results: AHC attendance among the elderly increased from 2011 to 2018, with higher utilization of AHC also detected in the rural group. AHC had positive effects on SRH among rural respondents (short-term effect: OR = 1.567, p < 0.05; long-term effect: OR = 3.385, p < 0.001).

Conclusion: This study highlights a higher utilization of AHC in rural area, and the effectiveness of AHC in SRH improvement among rural participants. It indicates enhanced access to public healthcare services in rural area and underlying implications of health check-ups for reducing urban–rural health inequalities.

Prevalence and Correlates of Hypertension among Japanese Adults, 1975 to 2010

We investigated the prevalence and factors associated with hypertension, its treatment, and control using individual-level data from 300,249 respondents aged 20 years and older from the Japanese National Health and Nutrition Survey for the period of 1975–2010. We applied multivariate random effects logistic regression to assess associations between the risk factors and the prevalence of hypertension, the proportion of uncontrolled hypertension, and the proportions of respondents seeking treatment and controlling hypertension. The trends in the effect of the birth cohort on uncontrolled hypertension were also examined. Having hypertension was associated with being male, older, obese, drinking alcohol, and working in the primary industry and a higher proportion of middle-aged men than women were found being obese and drinking alcohol. Seeking treatment was associated with being older, obese, drinking alcohol, working in a primary industry and exercising. Controlling hypertension was associated with being younger, underweight and exercising. The proportion of individuals with uncontrolled hypertension declined for cohorts born in later years with a steeper decline for women than men. Raising awareness in the hypertensive population, especially among men, could help further reduce the prevalence of hypertension in Japan.

Association between health risks and frailty in relation to the degree of housing damage among elderly survivors of the great East Japan earthquake

Background

Many survivors of the Great East Japan Earthquake that occurred in 2011 were at risk of deteriorating health, especially elderly people living in disaster-stricken areas. The objectives of this prospective study were: a) to clarify the different lifestyle and psychosocial factors associated with frailty by sex among the non-disabled elderly survivors, and b) to describe the differences in characteristics stratified by the degree of disaster-related housing damage.

Methods

We followed 2261 Japanese survivors aged ≥65 years (45.3% male; mean age, 71.7 years) without disability or frailty who completed a self-administered questionnaire at baseline. All participants completed a baseline questionnaire in 2011 and at least one identical follow-up questionnaire between 2012 and 2015 regarding lifestyle (smoking status, alcohol intake, physical activity, sedentary lifestyle, and dietary intake) and psychosocial factors (self-rated health, standard of living, psychological distress, and social networks). Frailty was defined as a score of ≥5 on the Kihon Checklist, which is used by the Japanese government to certify the need for long-term care insurance. Adjusted odds ratios and 95% confidence intervals with frailty as the dichotomous dependent variable and health factors as the independent variables were calculated using a multilevel model for repeated measures by sex, followed by stratification analyses by the degree of housing damage.

Results

Over the 4-year study period, 510 participants (22.6%) developed frailty. In the post-disaster setting, many of the psychosocial factors remained more prevalent 4 years later among survivors with extensive housing damage. The presence of risk factors regarding the development of frailty differed by the degree of housing damage. Among men, psychological distress, in parallel with a poor social network, was related to frailty among only the participants with extensive housing damage and those living in temporary housing, whereas among women, worsening psychological distress was associated only with no damage and no displaced survivors. Among women with extensive damage and displacement, health outcomes such as overweight and diabetes and poor social networks were strongly related to frailty.

Conclusions

Lifestyle and psychosocial factors associated with the risk of frailty differ by sex and the degree of housing damage.

Electronic supplementary material

The online version of this article (10.1186/s12877-018-0828-x) contains supplementary material, which is available to authorized users.

Rationale and Descriptive Analysis of Specific Health Guidance: the Nationwide Lifestyle Intervention Program Targeting Metabolic Syndrome in Japan

AIM

All health insurers in Japan are mandated to provide Specific Health Checkups and Specific Health Guidance (SHG) focusing on metabolic syndrome (MetS) in middle-aged adults, beginning in 2008; intensive HG for individuals who have abdominal obesity and two or more additional MetS risk factors, and motivational HG for individuals with one risk factor. The aim of this study is to describe medium-term changes in health indexes for intensive and motivational HG groups using the National Database.

METHODS

We compared changes of risk factors and initiation of pharmacological therapy over 3 yr between participants (n=31,790) and nonparticipants (n=189,726) who were eligible for SHG in 2008.

RESULTS

Body weight reduction in intensive HG was 1.98 kg (participants) vs 0.42 kg (nonparticipants) in men (p＜0.01) and 2.25 vs 0.68 kg in women (p＜0.01) after 1 yr. In motivational HG, the respective reduction was 1.40 vs 0.30 kg in men (p＜0.01) and 1.53 vs 0.42 kg in women (p＜0.01). Waist circumference reduction was also greatest among participants in intensive HG (2.34 cm in men and 2.98 cm in women). These reductions were fairly unchanged over 3 yr and accompanied greater improvements in MetS risk factors in participants. We also detected significantly smaller percentages of SHG participants who initiated pharmacological therapy compared with nonparticipants.

CONCLUSION

Participants in SHG showed greater improvements in MetS profiles with proportionally smaller pharmacological treatment initiations than did nonparticipants for 3 yr. Although selection bias may be present, this study suggests SHG would be a feasible strategy to prevent MetS and its sequelae.

Rural-urban difference in the use of annual physical examination among seniors in Shandong, China: a cross-sectional study

BACKGROUND

Regular physical examination contributes to early detection and timely treatment, which is helpful in promoting healthy behaviors and preventing diseases. The objective of this study is to compare the annual physical examination (APE) use between rural and urban elderly in China.

METHODS

A total of 3,922 participants (60+) were randomly selected from three urban districts and three rural counties in Shandong Province, China, and were interviewed using a standardized questionnaire. We performed unadjusted and adjusted logistic regression models to examine the difference in the utilization of APE between rural and urban elderly. Two adjusted logistic regression models were employed to identify the factors associated with APE use in rural and urban seniors respectively.

RESULTS

The utilization rates of APE in rural and urban elderly are 37.4% and 76.2% respectively. Factors including education level, exercise, watching TV, and number of non-communicable chronic conditions, are associated with APE use both in rural and urban elderly. Hospitalization, self-reported economic status, and health insurance are found to be significant (p < 0.05) predictors for APE use in rural elderly. Elderly covered by Urban Resident Basic Medical Insurance (URBMI) (p < 0.05, OR = 1.874) are more likely to use APE in urban areas.

CONCLUSIONS

There is a big difference in APE utilization between rural and urban elderly. Interventions targeting identified at-risk subgroups, especially for those rural elderly, are essential to reduce such a gap. To improve health literacy might be helpful to increase the utilization rate of APE among the elderly.

Personal status of general health checkups and medical expenditure: A large-scale community-based retrospective cohort study

Background

We sought to clarify the association between the personal utilization of general health checkups (GHCs) and medical expenditures (MEs) in a middle-aged Japanese population.

Methods

A retrospective cohort study was conducted. Subjects were 33,417 residents (15,819 males and 17,598 females) aged 48 years or older in 2010 who were invited to undergo GHCs every year. Official records on GHCs from 2002 to 2007 and MEs from 2008 to 2010 were provided by Soka City, Saitama Prefecture, Japan. The utilization of GHCs was divided into zero times (non-utilizers), 1–3 times (low-frequency utilizers), and 4–6 times (high-frequency utilizers). Tweedie distributions in the generalized linear model were used to analyze the association between MEs and the subgroups of GHC utilization after adjustment for age and sex.

Results

Of the 33,417 subjects, 20,578 (61.6%) were non-utilizers, 5,777 (17.3%) were low-frequency utilizers, and 7,062 (21.1%) were high-frequency utilizers, based on the attendance to GHCs from 2002 to 2007. Compared with the non-utilizers, the high-frequency utilizers showed significantly higher outpatient MEs (JPY394,700 vs. JPY373,100). The low- and high-frequency utilizers showed significantly lower inpatient MEs (JPY224,000 and JPY181,500 vs. JPY309,300) and total MEs (JPY610,600 and JPY580,700 vs. JPY689,600) than the non-utilizers based on the pooled data from 2008 to 2010.

Conclusions

This study suggests that the outpatient MEs rise when annual GHCs are increasingly attended (not including the GHC cost), but inpatient and total MEs are lower. To reduce MEs, increasing the rates of attendance at GHCs by the general public may be important.

•

To clarify the association between General Health Checkups and Medical Expenditures.

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A retrospective cohort study was conducted in a middle-aged Japanese population.

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Non-, low-, and high-frequency utilizers were divided based on the 6-year GHCs.

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3-year MEs were analyzed using Tweedie distribution for a generalized linear model.

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Outpatient MEs rise when GHCs are frequent, but inpatient and total MEs are lower.

The Effect of Free Adult Preventive Care Services on Subsequent Utilization of Inpatient Services in Taiwan

The objective of this article is to investigate the relationship between the utilization of free adult preventive care services and subsequent utilization of inpatient services among elderly people under the National Health Insurance program in Taiwan. The study used secondary data from the 2005 Taiwan National Health Interview Survey and claim data from the 2006 Taiwan National Health Insurance Research Database for the elderly aged 65 or over. A bivariate probit model was used to avoid the possible endogeneity in individuals’ utilization of free adult preventive care and inpatient services. This study finds that, when individuals had utilized the preventive care services in 2005, the probability that they utilized inpatient services in 2006 was significantly reduced by 13.89%. The findings of this study may provide a good reference for policy makers to guide the efficient allocation of medical resources through the continuous promotion of free adult preventive care services under the National Health Insurance program.

Relationship between Health-Seeking Behavior by Basic Health Examination and Subsequent Health Expenditure among Remote Island Inhabitants of Japan

BACKGROUND

Convincing evidence has not been obtained as to whether having a basic health examination in the prime of life inhibits the surge of health expenditure in old age.

DATA SOURCES

Data on participants in the basic health examination from 1996 to 2000 among residents of a remote island in Japan, and individual health care expenditure data from March 2005 to February 2008.

STUDY DESIGN

A community-based retrospective study.

DATA COLLECTION

Japanese residents who were subscribers to the National Health Insurance Scheme of Chibu Town from March 1996 to March 2007 and were aged 40 to 64 years in March 1996 (n = 179) were divided into 3 groups depending on the frequency of participating in the basic health examination over 5 years: 0 times (nontakers), 1 to 3 times (occasional takers), or 4 to 5 times (regular takers). The distribution of total health expenditure according to the frequency of having a basic health examination was determined, and the Cochrane-Armitage test was used for comparison.

RESULTS

Nontakers formed the highest proportion of subjects with low expenditure (0-200,000 yen) (nontaker, occasional, regular: 38.5%, 24.1%, 23.5%; P = 0.002), and also accounted for the highest proportion of subjects with high expenditure (> 1,400,000 yen) (33.3%, 16.1%, 9.4%; P = 0.004).

CONCLUSION

Persons not participating in health examinations during middle age include a group with high future health care expenditure.

Do interventions to prevent lifestyle-related diseases reduce healthcare expenditures? A randomized controlled clinical trial

BACKGROUND

In 2008, the Japanese government implemented a program of health lifestyle interventions to reduce health care expenditure. This study evaluated whether these interventions decreased health care expenditures.

METHODS

The study enrolled 99 participants insured by Japanese National Health Insurance, who, in our previous study conducted in 2004, were allocated by random sampling into an intervention group (50 participants) and a control group (49 participants). In the intervention group, we used a health support method that facilitated the attainment of goals established by each participant. The control group received instruction in exercise, as well as health support using publically available media. Although 3 participants in the intervention group and 9 participants in the control group did not participate in a follow-up health examination 1 year after the intervention, the health care expenditures of all initial participants were assessed. Expenditures before and after the intervention were compared within and between groups. Data on health care expenditures were obtained from inpatient, outpatient, pharmacy, and dental health insurance claims.

RESULTS

After the intervention, the pharmacy and dental expenditures were significantly higher in the intervention group, while the pharmacy expenditure was significantly higher in the control group. However, there was no significant difference in any medical expenditure item between the intervention and control groups before or after the intervention.

CONCLUSIONS

No significant differences were observed in short-term medical expenses for any medical expenditure item after a lifestyle intervention.

Participation in health check-ups and mortality using propensity score matched cohort analyses

OBJECTIVE

All Japanese aged ≥40 years are eligible for free annual health check-ups including blood pressure and cholesterol measurements. It is well known that health check-up screenees are more likely to have healthy lifestyles and better health conditions than non-screenees. Therefore, controlling these factors is required to investigate whether screenees have a lower mortality risk than non-screenees independent of their lifestyles or health conditions.

METHODS

We followed 48,775 Japanese National Health Insurance beneficiaries aged 40-79 years since 1994 for 11 years. We used Cox proportional hazard models adjusted for possible confounding factors. We also performed propensity for use of the health check-up matched cohort analyses.

RESULTS

Compared to non-screenees, multiple-adjusted hazard ratios (95% confidence intervals) for all-cause and cardiovascular disease mortality among screenees were 0.74 (0.62-0.88) and 0.65 (0.44-0.95) for men and 0.69 (0.52-0.91) and 0.61 (0.36-1.04) for women, respectively. These relations were also observed when we used propensity matched cohort analyses.

CONCLUSION

This is the first study to show that mortality rates are lower among screenees than non-screenees in Japanese health check-ups when propensity matched cohort analyses were used for adjusting confounding factors. Further prospective studies, including randomized controlled trials, are required to confirm whether screening lowers mortality.

Self-reported hearing difficulty and hearing Okamoto/Nakanishi/Tatara impairment in Japanese people living in a community

Nine hundred and eighteen people aged 40 years and over were examined to assess the relationship between self-reported hearing difficulty and hearing impairment at 1 kHz and 4kHz during annual health check-ups. After adjustment for potential confounding factors of self-reported hearing difficulty such as age, sex, noise exposure, ear disease and tinnitus. the odds ratios for self-reported hearing difficulty at 1 kHz compared with a hearing threshold of 30 dB were 1.74. 3.37 and 4.97 for hearing thresholds of 40 dB, 50 dB, and over 50 dB, respectively (p-value for trend = 0.003). At 4 kHz, the respective odds ratios for self-reported hearing difficulty were 1.53, 2.59 and 1.83 (p-value for trend = 0.012). These results suggest that self-reported hearing difficulty is closely associated with the severity of hearing impairment at 1 kHz and 4 kHz in a community-residing population and that people with hearing impairment at 1 kHz would be more sensitive to their hearing difficulty than those with hearing impairment at 4 kHz.

The relationship between self-reported difficulty with hearing in the worse ear and the better ear

OBJECTIVES

To investigate the relationship of self-reported hearing difficulty with hearing in the worse ear and the better ear at 1 and 4 kHz.

DESIGN

Receiver-operating characteristic (ROC) curve analysis in community-residing population.

SETTINGS

The Settsu City Health Center (Osaka, Japan).

PARTICIPANTS

A total of 919 consecutive participants who were provided health check-ups.

MAIN OUTCOMES MEASURES

Comparison is based on the measurement of the area under the curve (AUC) of ROC.

RESULTS

At 1 kHz, the area under the curve (AUC) of the worse ear (0.625 +/- 0.021) was significantly larger than that of the better ear (0.570 +/- 0.021) (P < 0.01). At 4 kHz, the AUC of the worse ear (0.665 +/- 0.019) was significantly larger than that of the better ear (0.622 +/- 0.020) (P < 0.01). Excluding the subjects with noise exposure, tinnitus and ear disease, at both frequencies, the AUC of the worse ear was not significantly larger than that of the better ear at both 1 and 4 kHz. Hearing in the worse ear was significantly more related to self-reported hearing difficulty than in the better ear without excluding those with noise exposure, tinnitus and ear disease.

CONCLUSIONS

ROC curve analysis would provide a method to help us judge the difference between the worse hearing ear and the better hearing ear on the subject of hearing loss.

Relationship of health services to medical expenses for the national health insurance and certification rate for long-term care insurance services in municipalities

In many municipalities, implementation rates of health services mandated by the Health and Medical Service Law for the Elderly have not reached the national goal that was set at the start. This study aimed to evaluate the effects of health services using medical expenses for the National Health Insurance (NHI) and certification rate for long-term care insurance services in 99 municipalities in Gifu Prefecture as indices. Both indices were standardized by the age composition of the population. Among the health services, visit rates for health examinations or implementation rates for health education or health counseling correlated negatively with medical expenses for each insured person. The visit rate for gastric cancer screening correlated negatively with medical expenses for malignant neoplasms of the stomach. Implementation rates of health education or health counseling, or ratios of public health nurses correlated positively with certification rates for long-term support need and care need grade 1, and negatively with those for long-term care need grades 2, 3, and 4. The author concluded that medical expenses are reduced by the implementation of available health services, that early detection and prevention of aggravation of disease is essential for those who need long-term care services, and that health services must be reinforced with primary prevention.

Does prompt treatment of hypertension after blood pressure check-ups reduce morbidity of cerebrovascular diseases?

In Japan, more than 20 million people utilize blood pressure check-up services in their work places or communities every year. To examine the relationship between prompt treatment of hypertension after these blood pressure check-ups and the severity, age at onset, and type of cerebrovascular diseases in these patients, a study was performed with the cooperation of all 174 independent physicians, 17 hospitals, and 4 welfare homes in the city of N.. All patients aged 50 years or more who visited a physician during the study period in this city were included in the study (n=978). Information on hypertensive control before the onset of cerebrovascular diseases was obtained from 668 patients. The results suggests that for those who had received prompt treatment after early detection of hypertension, the disease was less severe and the onset of the disease was delayed. Among our subjects, 47% of the patients claimed to have received prompt treatment after detection of hypertension. As N. is an ordinary Japanese city in terms of the promotion of health check-up programs, this percentage suggests that blood pressure check-up programs for the early detection of hypertension throughout Japan may have contributed to an overall reduction in severity for almost half of the patients with cerebrovascular diseases.

Health promotion for the elderly persons in Hong Kong

By the year 2000, there will be one million elderly persons in Hong Kong. With the rise of an older population, the cost of health care is likely to increase. Studies conducted in Hong Kong have shown that over 30% of health care expenditure is spent on the elderly. Unless steps are taken to slow the onset of chronic illnesses in elderly people, health care expenditure will increase rapidly in the future. The present paper describes strategies that have been adopted for promoting a healthier elderly population in Hong Kong. The paper also reports the results of an evaluative study on the largest health promotion program for older people in Hong Kong. It seems to show that health promotion activities may have the potential to save lives, delay institutionalization, and improve life satisfaction.

Do preventive health services reduce eventual demand for medical care?

The aim of this study was to find out whether there is any relation between the use of preventive health services provided for by municipalities under the Japanese Health Services for the Elderly Act and the demands for in-patient and out-patient care by insured residents aged 40 or older who were covered by the National Health Insurance, eligible for preventive health services under the act, in nine cities within the same catchment area in Osaka Prefecture. Main outcome measures were correlation coefficients between the use of in-patient and out-patient care, and (1) the rate of use of health check-ups, and (2) the cost for preventive health services per resident. Hospital admission rate per 1000 insured persons had a strong negative correlation with the rate of use of health check-ups. The rate of long stay, 180 days or more, per 1000 insured persons was also negatively correlated with the rate of use of health check-ups. There were negative correlations between the rate of use of health check-ups and both the in-patient cost per insured person, and the rate of high in-patient cost, 600,000 Yen or more, per 1000 insured persons. On the other hand, out-patient utilization rate per 1000 insured persons had a positive correlation with the rate of use of health check-ups. However, there was a negative relation between the rate of use of health check-ups and the out-patient cost per insured person because of negative associations between the rate of use of health check-ups and the out-patient days, and cost per case. The rate of high out-patient cost, 60,000 Yen or more, was negatively correlated with out-patient utilization rate per 1000 insured persons. Negative relations were also shown between the cost for preventive health services per resident and the in-patient and out-patient cost per case and per insured person, except out-patient utilization rate per 1000 insured persons. The correlation coefficient between the cost for preventive health services per resident and the total medical cost per insured person was r = -0.779 (P = 0.007). Provision of preventive health services under the Health Services for the Elderly Act may possibly improve health management in the early stage of diseases by detecting abnormalities in health, and that investing in prevention might contribute to reducing the subsequent total demand for medical care.

Regulatory effects of health examination programs on medical expenditures for the elderly in Japan

In order to evaluate if there is any correlation between the use of general medical examination programs organized by each community under the Health Service Law for the Elderly, and the medical expenditures for the elderly, an analysis was conducted based on 97 communal data of Fukuoka prefecture, Japan in 1991. According to the results, the use of health examinations showed a statistically significant negative correlation with the medical expenditures for the elderly both for in- and outpatient services. The analysis of the medical expenditure components has clarified that this negative correlation is mainly due to the low utilization rate of services at medical facilities among the communities with a high participation rate in the examination. A part of this low utilization rate could be explained by the complementary effect of the examination program as an alternative for the elderly instead of going to a medical facility for consultation. The present result suggests that a community health service program could decrease the demand for medical services of the elderly.

Mortality of frail elderly people living at home in relation to housing conditions

STUDY OBJECTIVE

The study was undertaken to identify any relationship between the mortality of frail elderly people living at home and their housing conditions.

DESIGN AND SETTING

A cohort of frail elderly people living in Yao City, Osaka Prefecture, Japan was followed for six years. Data on demographic variables, activities of daily living, the disease that was the main cause of the disability, medical treatment, the feasibility of continuing family care, and some housing conditions were collected in December 1983 by interview during home visits. Deaths were checked for each year for five years.

SUBJECTS

Altogether 423 people aged 65 years or more living at home in Yao City who were disabled and housebound for at least three months were studied.

MEASUREMENTS AND MAIN RESULTS

Life table analysis and multivariate logistic regression analysis were done. The cumulative survival rates of old people with good housing conditions were higher than those with poor housing conditions in each group stratified by age, sex, or the activities of daily living level. The odds ratio for poor housing conditions compared with good housing conditions for five year mortality remained highly significant after adjustment for potential confounding factors including age, sex, and the activities of daily living level by logistic regression analysis.

CONCLUSIONS

The mortality of frail elderly people living at home is affected by housing conditions. Programmes to improve housing conditions of the disabled are important for home care of the elderly.